Insights

Industry Leader in Coding Sees Influx in Home Health Claim Denials Due to Lack of Guidance for New ICD-10-CM Codes

Posted on Friday, October 26, 2018 12:20 PM

Written by: Nick Dobrzelecki, RN, Sr. Vice President of Coding

As of October 1, 2018, 435 ICD-10-CM coding changes have been implemented. This is the third mandated update to ICD-10 codes since going live in 2015. Traditionally with each update CMS has released supplemental guidance for home health to help coders, providers, payers, auditors, educators and consultants to be clear on which specific OASIS dates drive specific FY data set. Unfortunately, that key piece was not included the most recent mandated update.

As the coding partner for many large agencies in the country, Corridor is seeing an increase in denials by commercial insurance companies. We feel this influx is due to a lack of clarification on the implementation process for the ICD-10-CM update from CMS. We are seeing some denials due to payers wanting to use the new codes on patient encounters that occur outside the October 1, 2018 to September 30, 2019 window.

Corridor is making all efforts to take care of its clients by addressing the denials and provide direction on re-filing the claims. For future data set changes, our goal is to work together with NAHC (National Association of Home Care and Hospice) and CMS to simplify changes to an already complex system and develop a better coding update transition plan. While there were not as many changes this year as there have been in previous years, it is important for all parties to be on the same page to prevent coding accuracy and reimbursement issues.

The 2019 ICD-10-CM updates include 279 new codes, 143 revised codes, 51 deactivated codes, and 71,932 total codes to be used for patient encounters occurring from October 1, 2018 through September 30, 2019.

About Corridor

Corridor is the nation’s preferred partner and trusted business advisor to home health and hospice providers, providing quality services and impactful results for 30 years.
Focusing on key operational, regulatory and financial challenges, Corridor delivering industry-unique solutions and deep expertise in coding, clinical documentation review, compliance, billing and collections , consulting and provider staff education .
At Corridor, we make the business of caring for people Better!
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